Protocol for a randomized controlled trial of a specialized health coaching intervention to prevent excessive gestational weight gain and postpartum weight retention in women : the HIPP study

Background

Pregnancy is a time of significant physiological and physical change for women. In particular, it is a time at which many women are at risk of gaining excessive weight. We describe the rationale and methods of the Health in Pregnancy and Post-birth (HIPP) Study, a study which aims primarily to determine the effectiveness of a specialized health coaching (HC) intervention during pregnancy, compared to education alone, in preventing excessive gestational weight gain and postpartum weight retention 12 months post birth. A secondary aim of this study is to evaluate the mechanisms by which our HC intervention impacts on weight management both during pregnancy and post birth.
Methods/Design

The randomized controlled trial will be conducted with 220 women who have a BMI > 18.5 (American IOM cut-off for normal weight), are 18 years of age or older, English speaking, no history of disordered eating or diabetes and are less than 18 weeks gestation at recruitment. Women will be randomly allocated to either a specialized HC intervention group or an Education Alone group. Our specialized HC intervention has two components: (1) one-on-one sessions with a Health Coach, and (2) two by two hour educational group sessions led by a Health Coach. Women in the Education Alone group will receive two by two hour educational group sessions with no HC components. Body Mass Index, waist circumference, and psychological factors including motivation, readiness to change, symptoms of depression and anxiety, and body dissatisfaction will be assessed at baseline (14-16 weeks gestation), and again at follow-up: 32 weeks gestation, 6 weeks, 6 months and 12 months postpartum.
Discussion

Our study responds to the urgent need to design effective interventions in pregnancy to prevent excessive gestational weight gain and postpartum weight retention. Our pregnancy HC intervention is novel and innovative and has been designed to be easily adopted by health professionals who work with pregnant women, such as obstetricians, midwives, allied health professionals and health psychologists.

A conceptual model of psychological predictors of postpartum weight retention

Obesity and being overweight affect almost half of all women of childbearing age, with postpartum weight retention (PWR) being a key contributing factor. Retention of postpartum weight has a number of negative health implications for mothers and offspring, including longer-term higher body mass index (BMI). There is increasing evidence that psychological factors are associated with PWR, including depressive symptoms, anxiety, stress, and body dissatisfaction. However, what is less known is how these psychological factors might interact with maternal physiological and physical weight factors, sociocontextual influences, pregnancy-related medical factors, and maternal behaviours to lead to PWR. We have incorporated identified psychological influences within an empirically supported, multifactorial, conceptual model of hypothesised predictors of PWR, and argue that a systematic and rigorous evaluation of this conceptual model will inform the development of appropriate prevention strategies.

Cambodian migrant women's postpartum experiences in Victoria, Australia

Objective: to explore the postpartum experiences of Cambodian born migrant women who gave birth for the first time in Victoria, Australia between 2000 and 2010. Design: an ethnographic study with 35 women using semi-structured and unstructured interviews and participant observation; this paper draws on interviews with 20 women who fit the criteria of first time mothers who gave birth in an Australian public hospital. Setting: the City of Greater Dandenong, Victoria Australia. Participants: twenty Cambodian born migrant women aged 23-30 years who gave birth for the first time in a public hospital in Victoria, Australia. Findings: after one or two home visits by midwives in the first 10 day postpartum women did not see a health professional until 4-6 weeks postpartum when they presented to the MCH centre. Women were home alone, experienced loneliness and anxiety and struggled with breast feeding and infant care while they attempted to follow traditional Khmer postpartum practices. Implications for practice: results of this study indicate that Cambodian migrant women who are first time mothers in a new country with no female kin support in the postpartum period experience significant emotional stress, loneliness and social isolation and are at risk of developing postnatal depression. These women would benefit from the introduction of a midwife-led model of care, from antenatal through to postpartum, where midwives provide high-intensity home visits, supported by interpreters, and when required refer women to professionals and community services such as Healthy Mothers Healthy Babies (Victoria Department of Health, 2011) for up to 6 weeks postpartum

Psychological management of unipolar depression

Objective: To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. Method: Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. Results: Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. Conclusion: Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

Psychological distress across pregnancy and postpartum: a prospective study

This thesis focused on exploring women’s experiences pre- and post birth using a longitudinal design. A comprehensive trajectory of distress levels was attained (by assessing symptoms of depression, anxiety and stress), and the unique role of coping and cognitive appraisal strategies were also investigated.

Habitual visualizer/verbalizer cognitive style: the impact of anxiety and depression

Imagery and verbal cognitive abilities appear to be differentially affected by psychopathology, yet research has failed to consider Paivio's proposition that people have habitual cognitive styles. The aim of this study was to establish habitual cognitive style (verbalizer/visualizer) among depressed, anxious, and control respondents and compare these to their imagery and verbal abilities in the state mode. A comparison of these groups confirmed that there were no differences in preferred habitual cognitive style. In the state mode, the anxious group demonstrated the highest imagery vividness and the depressed group the lowest. Both clinical groups demonstrated attenuated verbal reasoning and high levels of confusion. Within-groups comparison confirmed the attenuation of verbal ability for both clinical groups while the control group remained stable. All three groups demonstrated enhanced state imagery ability over habitual visual preference. This change was greatest for the anxious group followed by the control and then the depressed groups. The therapeutic implications of these findings are discussed .

Cognitive functioning in chronic fatigue syndrome and the role of depression, anxiety and fatigue

Objective: This study was designed to investigate the role of depression, anxiety, and fatigue in Chronic Fatigue Syndrome (CFS) sufferers' objective and subjective cognitive performance. Methods: Twenty-three CFS sufferers and 23 healthy control participants were compared on objective and subjective assessments of cognitive performance. Depression, anxiety, and fatigue were also evaluated. Results: CFS sufferers did not demonstrate any impairment in objective cognitive functioning compared to the control group, and objective performance was not related to their higher levels of depression or their level of fatigue. Depression scores only accounted for a small amount of the variance in CFS sufferers' lower subjective assessment of their cognitive performance compared to control participants. There were no differences between the groups on anxiety scores. Conclusion: The results are discussed in terms of the heterogeneity of the CFS population and the complex interaction of symptomatological factors that characterise CFS.

The psychological impact of a cancer diagnosis on families: the influence of family functioning and patients' illness characteristics on depression and anxiety

A diagnosis of cancer is a very stressful event for the patients and their families. Patients, partners and other family members can suffer from clinical levels of depression and severe levels of anxiety and stress reactions. The similarity in levels of distress between patients and partners and patients and offspring suggests that there are common factors that impact on families' distress levels. The current study examined levels of depression and anxiety in newly diagnosed adult patients (n = 48) and their adult relatives (n = 99). Family functioning and patients' illness characteristics were identified as factors that might impact on families' depression and anxiety. Results from multilevel models indicated that family functioning was important. Families that were able to act openly, express feelings directly, and solve problems effectively had lower levels of depression. Direct communication of information within the family was associated with lower levels of anxiety. Aside from differences anxiety due to cancer type, patients' illness characteristics appear to be risk factors in patients' but not relatives' depression and anxiety. The results from the current study suggest that researchers and clinicians need to be family-focused as cancer affects the whole family, not just the patient.

Depression and expression: life begins on the other side of despair

This paper has two parts. In Part I, it consists of a letter written by the subject of the ‘case study’ that forms the basis of Part II. Part I demonstrates how the writer Aliki Pavlou discovered that, in attempting to help a friend face uncomfortable truths in relation to his perception of his mother, she inadvertently was able to voice her own dilemma in relation to her mother that hitherto had been elusive.
This paper forms a part of a larger project being researched by Aliki Pavlou, Justin Clemens and me. The study, to be entitled, "In the Heart of Hell: Depression and its Expression," is one that contends that Literature expresses the ineffable nature of depression in its symbolic mode; that, indeed, literary texts reveal in their concealment. The work therefore argues that ‘depression’ is expressible.
Part II of this paper analyses the response of a depressive to Jean-Paul Sartre’s novel Nausea (1964). Beginning with a brief discussion of the role of the ‘mother’ as psychologically pivotal in some depressives’ struggle towards well-being, this section analyses a reading of Nausea by a depressive. The objective of this study was to ascertain the extent to which the condition of nausea, as represented in Sartre’s novel, expresses the experience of depression.

The Relationship of Childhood Family Characteristics and Current Attachment Styles to Depression and Depressive Vulnerability

The role of adult romantic attachment style in the relationship between childhood experiences and current depression was examined. Childhood maltreatment, parental separation/divorce, family adaptability and cohesion during childhood, current attachment style in romantic relationships, vulnerability to depression, and current depressive symptoms were measured in a self-selected sample of adults (N = 133). A large degree of overlap was found in the experience of different types of maltreatment during childhood. Depressive symptoms were uniquely predicted by the sexual abuse and neglect scales, with significant additional variance explained after entering the degree to which respondents' current romantic attachment style was “secure”. Maltreatment and family dysfunction in childhood were significant predictors of depression and vulnerability to depression. Although maltreatment scores did not differentiate between different attachment styles, the degree to which respondents were securely attached may explain -in part -the association between early childhood environment and depressive symptoms in adulthood.

Feel blue? Touch green! Participation in forest/woodland management as a treatment for depression

Recent research by a team from Deakin University explored the health and wellbeing benefits of civic environmentalism – voluntary communal actions undertaken to promote ecosystem sustainability, typified by membership of a ‘friends of parks’ group. The research confirmed what was known intuitively: that belonging to such a group and undertaking the activities associated with such a group exposes people not only to the benefits of the natural environment, but also to other people and to opportunities to make a contribution which is socially valued.

On the basis of those findings, a pilot project involving intentional engagement of people suffering depression and related disorders in supported nature-based activities in a woodland environment is being implemented and evaluated. This article reports on that project and discusses the implications of its findings to date, and the findings of the three earlier projects, both for urban woodland/forest managers and for the health sector.

As this contribution indicates, there appears to be potential for the use of civic environmentalism to promote health, wellbeing and social connectedness for individuals and the wider population, as well as for groups with identified health vulnerabilities. However, the realization of the benefits of such an approach will be dependent on co-operation between the environment and health sectors to create and promote opportunities for increased civic environmentalism, and to identify and address the barriers to their effective use.

Satisfaction with general practitioner treatment of depression among residents of aged care facilities.

Objective: This article investigates consumer perspectives on the treatment for depression among older people in residential facilities. Method: Aged care residents who were aware of being treated for depression in the past 6 months (24 women and 7 men, mean age = 83 years) participated in an interview that assessed their perspective on treatments. Results: Although more than half of the participants in the sample reported overall satisfaction with the medical treatments received for depression, qualitative data provided indications of unsatisfactory service delivery, including perceptions of low treatment efficacy, short consultation times, the failure to assess affective symptomatology, and negative responses to residents’ disclosure of symptoms. Discussion: The findings are discussed in relation to previous research on consumer satisfaction with health services and issues that may be pertinent to the elderly depressed. Training for general practitioners providing treatment in aged care is indicated.

No outbreeding depression at a regional scale for a habitat-forming intertidal alga with limited dispersal

Hormosira banksii is distributed throughout southern Australasia, but dispersal of propagules is thought to be limited. In the present study, the hypothesis that outbreeding depression occurs in H. banksii was tested by assessing fertilisation success and early development of embryos in crosses between populations at local to regional spatial scales. Hierarchical experiments were conducted at three spatial scales with nesting present within each scale: small scale (within a rocky shore population), intermediate scale (regions separated by 70 km) and large scale (450-km separation between two states: Victoria and Tasmania). In each experiment, eggs and sperm were crossed within and between each population located in the spatial scale of interest. There were no consistent patterns of variable fertilisation success and subsequent development within a population or at different spatial scales. It was concluded that outbreeding depression is not detected in analyses of fertilisation success or early development processes in H. banksii. The results suggest one of the following to be likely: (1) H. banksii is capable of longer distance dispersal than previously considered, thus maintaining gene flow between distant populations, (2) gene flow is restricted by limited dispersal, but populations have not been isolated for a sufficient length of time to cause genetic divergence or (3) outbreeding depression is manifested as effects on later life-history stages.